Diabetes & Urologic Problems

Bladder dysfunction can have a profound effect on
quality of life. Diabetes can damage the nerves that
control bladder function. Men and women with
diabetes commonly have bladder symptoms that may
include a feeling of urinary urgency, frequency,
getting up at night to urinate often, or leakage of
urine (incontinence). These symptoms have been
called overactive bladder. Less common but more
severe bladder symptoms include difficulty urinating
and complete failure to empty (retention). These
symptoms are called a neurogenic bladder. Some
evidence indicates that this problem occurs in both
men and women with diabetes at earlier ages than in
those without diabetes.

Neurogenic Bladder

In neurogenic bladder,
damage to the nerves that go to your bladder can
cause it to release urine when you do not intend to
urinate, resulting in leakage. Or damage to nerves
may prevent your bladder from releasing urine
properly and it may be forced back into the kidneys,
causing kidney damage or urinary tract infections.

Diabetes or other
diseases, accidents that damage the nerves, or
infections, can cause neurogenic bladder.

Symptoms of neurogenic
bladder include

urinary tract
infections

loss of the urge
to urinate when the bladder is full

leakage of urine

inability to empty
the bladder

Your doctor will check
both your nervous system (your brain and the nerves
of the bladder) and the bladder itself. Tests may
include x rays and an evaluation of bladder function
(urodynamics).

Treatment for
neurogenic bladder depends on the specific problem
and its cause. If the main problem is retention of
urine in the bladder, treatment may involve
medication to promote better bladder emptying and
behavior changes to promote more efficient
urination, called timed urination. Occasionally,
people may need to periodically insert a thin tube
called a catheter through the urethra into the
bladder to drain the urine. Learning how to tell
when the bladder is full and how to massage the
lower abdomen to fully empty the bladder can help as
well. If urinary leakage is the main problem,
medications or surgery can help.

Urinary Tract Infections

Infections can occur
in any part of the urinary tract. They are caused
when bacteria, usually from the digestive system,
reach the urinary tract. If bacteria are growing in
the urethra, the infection is called urethritis. The
bacteria may travel up the urinary tract and cause a
bladder infection, called cystitis. An untreated
infection may go farther into the body and cause
pyelonephritis, a kidney infection. Some people have
chronic or recurrent urinary tract infections.

Symptoms of urinary
tract infections may include

a frequent urge to
urinate

pain or burning in
the bladder or urethra during urination

cloudy or reddish
urine

fatigue or
shakiness

in women, pressure
above the pubic bone

in men, a feeling
of fullness in the rectum

If the infection is in
your kidneys, you may be nauseous, feel pain in your
back or side, and have a fever. Since frequent
urination can be a sign of high blood glucose, you
and your doctor should also evaluate recent blood
glucose monitoring results.

Your doctor will ask
for a urine sample, which will be analyzed for
bacteria and pus. If you have frequent urinary tract
infections, your doctor may order further tests. An
ultrasound exam provides images from the echo
patterns of soundwaves bounced back from internal
organs. An intravenous pyelogram (IVP) uses a
special dye to enhance x-ray images of your urinary
tract. Another test, called cystoscopy, allows the
doctor to view the inside of the bladder.

Early diagnosis and
treatment are important to prevent more serious
infections. To clear up a urinary tract infection,
the doctor will probably prescribe an antibiotic
based on the bacteria in your urine. Current
recommendations are for a full 7-day course of
antibiotic treatment in people with diabetes,
instead of the shorter course used for other people.
Kidney infections are more serious and may require
several weeks of antibiotic treatment. Drinking
plenty of fluids will help prevent another
infection.

Will I
Experience Sexual and Urologic Problems Sooner or
Later?

Risk factors are
conditions that increase your chances of getting a
particular disease. The more risk factors you have,
the greater your chances of developing that disease
or condition. Diabetic neuropathy, including related
sexual and urologic problems, appears to be more
common in people who

have poor blood
glucose control

have high levels
of blood cholesterol

have high blood
pressure

are overweight

are over the age
of 40

smoke

What
Can I do to Prevent Diabetes Related Sexual and
Urologic Problems?

You can lower your
risk of sexual and urologic problems by keeping your
blood glucose, blood pressure, and cholesterol close
to the target numbers your doctor recommends. Being
physically active and maintaining a healthy weight
can also help prevent the long-term complications of
diabetes. Smoking is a particular problem, and
quitting will improve your health in many ways. For
example, if you quit smoking, you can lower your
risk not only for nerve damage but also for heart
attack, stroke, and kidney disease.

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